粪菌移植对顽固性功能性便秘患者临床疗效及生活质量的影响

Effect of fecal microbial transplant on clinical outcomes and life quality in refractory functional constipation

目的评价粪菌移植(FMT)治疗顽固性功能性便秘的临床效果。方法选取2013年11月至2015年5月第四军医大学消化病院门诊就诊的顽固性功能性便秘患者,将符合纳入标准的60例患者采用数字表法随机分为治疗组和对照组,对照组给予聚乙二醇电解质散剂,治疗组在此基础上加以FMT,疗程4周。观察治疗前后患者Bristol粪便性状量表(BSFS)、便秘症状自评量表(KESS)的变化,进行疗效评价;采用便秘患者生活质量量表(PAC-QOL)评定治疗前后患者生活质量的改变。结果治疗前,治疗组和对照组患者BSFS[(1.23±0.50)vs.(1.20±0.48)分]、KESS[(27.93±4.98)vs.(25.60±5.48)分]及PAC-QOL[(111.40±15.06)vs.(110.30±19.11)分]评分差异均无统计学意义(P>0.05)。治疗后,两组患者BSFS评分均明显增加、KESS及PAC-QOL评分均明显下降,差异均有统计学意义(P<0.05),与对照组相比,治疗组BSFS评分明显增加[(2.37±1.20)vs.(3.10±1.13)分],KESS评分明显下降[(16.97±7.37)vs.(12.43±7.48)分],PAC-QOL评分明显下降[(87.13±27.52)vs.(63.10±26.40)分],差异均有统计学意义(P<0.05)。治疗组总有效率为83.3%,对照组总有效率为53.3%。两组治疗期间均未发生严重不良反应。结论 FMT联合聚乙二醇电解质散能安全、有效地改善顽固性功能性便秘患者的相关症状,提高患者的生活质量,为临床治疗顽固性功能性便秘提供了新的治疗方法,值得临床推广。

Objective To evaluate the clinical efficacy of fecal microbial transplant （ FMT） for patients with refractory functional constipation. Methods Sixty patients with refractory functional constipation who met inclusion criteria in Hospital of Digestive Disease of Fourth Military Medical University from November 2013 to May 2015 were selected. All patients were randomly assigned to groups that either underwent FMT after receiving polyethylene glycol electrolyte or were given only polyethylene glycol electrolyte（ control）for one month. The treatment outcome was measured by BSFS and KESS scores before and after treatment,and the PAC-QOL scores were assessed to evaluate the patients,quality of life. Results There was no significant difference of the scores of BSFS [（ 1. 23 ± 0. 50 ） n （ 1. 20 ± 0. 48 ）], KESS [ （ 27. 93 ± 4.98）^. （25.60 ±5.48）] and PAC-QOL [（111. 40 ± 15.06）^. （110.30 ± 19. 11）] between the FMT group and the control group before treatment （P 〉0. 05）. The significant improvements were obtained in the score of BSFS,KESS and PAC-QOL in the FMT group compared with the control group after treatment（P 〈 0. 05 ） . Compared with control group, significant overall improvements were seen in BSFS scores [（ 2. 37 ±1. 20） （ 3. 10 ± 1. 13 The improvements were also accompanied by the decrease of KESS [ （ 16. 97 ±1.31）vs. （ 12. 43 ± 7. 48 ） ] and PAC-QOL[ （ 87. 13 ± 27. 52） vs. （ 63. 10 ± 26. 40） ] scores. The total effective rates of the FMT group and the control group were 83. 3% and 53. 3% respectively. No severe adverse effects occurred during treatment. Conclusion FMT combined with polyethylene glycol provides a higher improvement rate in treatment with refractory functional constipation. It relieves the symptoms of patients and improves the quality of life. FMT combined with polyethylene glycol should be a reasonable choice to treat refractory functional constipation and deserve the clinical expansion.